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Monday, June 25, 2018

Overview

Back in January, the Trump Administration proposed a new rule that would expand the availability of Association Health Plans (AHPs) that are exempt from regulations like the 10 essential health benefits (EHBs) set by the Patient Protection and Affordable Care Act (ACA or Obamacare). This week, the Trump Administration released a finalized policy to allow loosely affiliated business to band together as AHPs and offer plans that are not held to many important ACA consumer protections. The coverage offered by these plans may be inadequate and will likely exclude patients with pre-existing conditions. While it is unlikely that cancer patients would be interested, or able, to purchase AHPs, there are still concerns regarding the impact this will have on individuals with chronic illnesses.

What Does This Rule Do?

Association Health Plans allow groups of small businesses to band together and purchase health insurance coverage for their employees. The plans:

  • May offer lower premiums than ACA compliant plans but may apply higher deductibles
  • May be medically underwritten so that they can only be purchased by healthy individuals—and if patients develop health conditions they can lose coverage when the contract ends
  • Can exclude patients based on pre-existing conditions
  • May not have to cover essential health benefits (such as prescription medications, mental health care, hospitalization, emergency services, etc.)
  • Not subject to cost sharing limits which puts patients at financial risk

What Does This Mean for Cancer Patients & Survivors?

The new rule creates uncertainty in the marketplace that will put cancer patients and survivors’ health coverage at risk. The expanded availability of these plans will likely attract young, healthier individuals due to the lower premiums. These plans may be less expensive than those offered under the ACA but they put patients at risk of losing important protections. They also misbalance the health care market which depends upon both patients living with illness (who may be higher cost) and healthy patients (who typically do not cost as much). Ultimately, if sicker patients are the only ones purchasing health insurance coverage through the ACA marketplace, they will be charged more.

Those enrolling in AHPs may face increased difficulty in accessing and affording the coverage they need, and could find themselves paying out-of-pocket for essential care because of the lack of protections or oversight on AHPs. Those left in the individual markets could see their health insurance costs increase as healthy individuals enroll in AHPs and drive up the price for those with higher cost healthcare needs.

Authority over the implementation of these expanded plans is also undefined, likely creating dramatic differences in coverage between states and a lack of enforcement for any plans sold across state lines. This final rule will ultimately reduce access to comprehensive health care for all, and will drive up health care costs for not only cancer patients and survivors, but all those enrolled in the marketplace.

The rule does include some protections for patients including a ban on denying coverage of an otherwise covered by pre-existing health conditions, a requirement that if a plan offers coverage for dependents it applies to children up to age 26, and a requirement to cover certain preventative health services without cost sharing. However these protections are unclear and only apply to plans created after the final ruling, exempting those created before the rule. The final rule also broadens state’s flexibility to tailor rules based on their local markets, meaning that coverage options can drastically vary based on location and some patients may receive benefits others cannot.

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